Price transparency, increasing revenue, and reducing denials are three of the revenue cycle’s thorniest issues.
At the HealthLeaders Revenue Cycle Ideas Exchange in mid-March revenue cycle leaders from the nation’s top health systems shared their proven strategies for success for each of these problems.
Here’s what they had to say.
Although root cause data showed that 47% of its hospital billing denials were related to some case management opportunity, the staff that was tasked with working on utilization management (UM) denials didn’t have much background in case management.
“It wasn’t their expertise, so we were not being effective in appealing these denials,” says Abongwa.
That’s why in 2019, they got a new position approved: A UM denial management registered nurse that reports to the revenue cycle department.
“It made a huge difference for us since we got her onboard the revenue cycle team,” Abongwa says.
When patients talk to their physicians about treatment options during a visit, they often ask the question that all consumers want to know when considering a big purchase: How much will it cost?
That’s why Ochsner Health System in Louisiana has made physician outreach and education part of its work on price transparency and how it provides pre-service estimates to patients.
In addition to proactively providing estimates for all scheduled services and providing an online self-service price estimate tool, Ochsner went live with a Central Pricing Office (CPO) in 2018, a call center which consists of a team of internal consultants that handle all the pricing questions for the system.
Physicians aren’t the only people who get asked cost questions. Leaders and employees systemwide get often get questions, too, so anyone who has a pricing question—whether it’s a clinical or non-clinical employee, or a price-shopping patient—gets routed through the CPO.
“A lot of physicians and [clinical] operators were saying that patients kept asking them [price] questions,” says Cardwell. “They didn’t feel like they had a great way to answer the patients at that point, so we really wanted to provide a resource for them to send their patients to get that information.”
There are big-picture, high-impact projects on every revenue cycle leader’s wish list, from implementing a new charity policy to installing a new claim system.
While these projects are important and necessary, they often take months or years to implement and require approvals from multiple outside departments, IT capital, and other resources.
Instead of always working on these “high effort, high impact” projects, McDermott encourages revenue cycle leaders to also focus on “low effort, high impact” projects that use what he calls a “no-huddle offense” strategy.
When football teams use a no-huddle offense strategy, they dispense with the time-consuming huddle and instead run prearranged plays that allow them to score quickly.
Revenue cycle leaders can apply the same idea to their own projects.
“The no-huddle offense is about creating these quick wins through projects that you have total control over, and you can move forward in 90 to 180 days,” McDermott says. “In the revenue cycle management sector, we’re under constant pressure to reduce costs and increase net patient revenue, so having a no-huddle offense is a really good part of your portfolio.”